Outline

Objective: While breakage of an orthopaedic instrument or implant is a relatively rare occurrence, surgeons performing surgery on bones and joints need to be familiar with this complication and how to deal with it. Knowledge about the frequency and the influences on patients are rare.

Methods: Every event of instrument breakage during orthopedic procedures performed in two different hospitals during a two-year prospective period was accurately documented. During a follow up period of between 12 to 36 months patients were observed, all occurrences were recorded. Each time, x-rays in two planes were performed to assess changes or migration.

Results and conclusions: During the observation period 11,856 surgical procedures were performed in the two different clinics. The overall rate of instrument breakage amounted to 0.35 percent. In five cases the broken piece was removed, 37 times the broken instrument was left in situ. During the follow up time none of the patients had any complaints. Removal of broken instruments had to be done according to the guidelines of this study. Metal bits had to be removed: 1. if mobile, 2. if penetrating both cortical substances of the bone, 3. if it is lying near vessels or nerves, 4. if resting near or in joints. The risk of harming the patient is small, if the guidelines for removal are carried out. By virtue of these facts preoperative education of the patient is not mandatory to our opinion. Nevertheless, if an instrument breakage happens during an orthopedic procedure, detailed information of the patient and accurate documentation of the event in the surgical record is recommended.